(PS11-27) Does DBT Skills Use Reduce Risk of Engaging in Non-suicidal Self-injury When Urge to Self Harm Is Elevated?

Non-suicidal self-injury (NSSI) is common in individuals with borderline personality disorder (BPD), with over 60% of people with the disorder having engaged in NSSI (Soloff et al., 2011). One treatment shown to be effective in reducing NSSI ideation (Rizvi & Fitzpatrick, 2020) and acts (Linehan, 2006) is Dialectical Behavior Therapy (DBT; Linehan, 1993a). DBT utilizes a skills deficit model wherein patients are taught new skills to replace problematic behaviors (e.g., NSSI). Indeed, Neacsiu et al. (2010) found that DBT skills were a key mechanism in DBT’s effectiveness in reducing NSSI. One remaining question from this work involves understanding the contexts under which DBT skills use relates to lower NSSI. Specifically, it is not currently known if using DBT skills helps reduce the risk of acting on NSSI urges. DBT patients track their daily skills use and engagement in target behaviors, such as NSSI, by recording these behaviors on a behavior monitoring tool called a diary card (Linehan, 1993b). The current study will use data from diary cards to examine the hypothesis that skills use reduces risk in engaging in NSSI when the urge to self-harm is high. 

Participants (n = 33) were a subset of a larger group of adults and adolescents that were receiving DBT as part of a research training clinic. All adult participants in the sample met criteria for BPD and adolescents had at least three symptoms. All completed at least one diary card. The participants had an average age of 22.84 (SD  = 8.42), were 93.9% female, and 42.4% white. We analyzed 2921 days extracted from 501 diary cards with each participant completing an average of 15.18 cards. We conducted multilevel moderated logistic regression to determine whether the relationship between urge to self-harm and engaging in NSSI was moderated by skills use during the day. We found that while there was a main effect suggesting people were more than four times as likely to engage in NSSI when they had urges to do so (OR = 4.35, 95% CI = [2.67, 7.08], p< .001), there was no main effect for skills use (p=.211) or an interaction between skills use and urge to engage in NSSI (p=.717). This study adds to the growing body of research on NSSI engagement in the context of DBT using ecological assessment in the form of diary cards.